Ask A Physio

FAQ – Ask A Physio

Our Physiotherapists answer your questions about physiotherapy as well as our treatment!

Ice and Heat. Which should I be using and when? EG

Ice is ideally used in the early stages of an injury, especially within the first 24 hours. At this time, ice helps to decrease pain, bleeding, and swelling. It also helps stop soft tissue damage from spreading to the surrounding areas.

Ice can be used for muscle spasms, acute swelling and inflammation, acute injuries and bruises. It can also be used for the first 24 hours to manage any on-going swelling.

Heat on the other hand should not be used in the first 24 hours after the injury. Heat can be used after this time to decrease pain and muscle spasm, treat chronic pain and swelling, and help decrease neck pain. It does this by increasing blood flow to the area.

With both ice and heat, use caution if you have circulatory problems or and sensitivity to hot or cold. Apply the ice or hot pack for no more than 15 minutes at a time, and check your skin afterwards to ensure no burns or skin damage has occurred.

Karen Forsman MPT BScKIN
Registered Physiotherapist
North Shore Sports Medicine: Deep Cove

I’ve never been to physiotherapy so how does it work? AR

When you come in for your initial appointment our therapist will preform an assessment where they obtain the information they need to form both a physiotherapy diagnosis of the problem and a treatment plan. After preforming this assessment they will speak with you about the appropriateness of physiotherapy treatment with your medical condition, various treatment options that physiotherapy can provide as well as make recommendations for further treatment frequency and duration.

Treatment options may include a combination of hands on treatment, various “modalities” such as ice, heat, electrical stimulation or acupuncture, specific rehabilitative exercises tailored to your needs, as well as education regarding your specific condition. As treatment progresses there will be an ongoing conversation between you and your therapist about the effectiveness of the treatment as well as frequency and duration of future appointments. Your physiotherapist can also provide information regarding other treatment options that are available should physiotherapy not be appropriate.

Anne Chicoine BScKin, MPT, CAFCI
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank, Deep Cove

What should I wear to my appointment? SL

You should wear comfortable loose clothing that allows you to move and should make your injury accessible to the therapist.

Christina Cassady MScPT
Registered Physiotherapist
North Shore Sports Medicine: Deep Cove

What happens if I miss an appointment? JC

If you cancel your appoint with less than 24 hours you will be assessed a cancellation fee of $60 for massage appointments. Otherwise we’ll do our best to find a time for another appointment with our therapists.

Christina Cassady MScPT
Registered Physiotherapist
North Shore Sports Medicine: Deep Cove

My lower back feels tight after I play hockey, what can I do before I play to help? SK

As a recreational hockey player I often find myself rushing to get to the rink and have only 5 min or less of warm up. That on ice time should be used to warm up stick and puck skills, not getting the core and legs warmed up. Warming up your core and legs is the most important thing you can do to protect your back by priming the core muscles.

It can start at home or at the rink but you must make it a part of your pregame ritual. Two foot squats, jumping jacks or light jogging for 10 minutes will start to warm up the core and legs. Both forward and side planks are great way to activate the core muscles. Finally while you are waiting for the zamboni gates to close stand on 1 skate and swing your leg in each direction ten times, then put you stick over your shoulders and twist side to side. Keeping active and having fun are all important components of preventing lower back problems.

Remember pain is not normal no matter what your age. Please consult a physiotherapist for more information or if you are having pain.

Dorothy Berwick MPT BSc
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank

How many visits will I need? JC

This depends on the injury, you and your goals. We work with you individually to ensure that there is a plan to get you back to your sport, your work and your life as soon as possible.

Paige Larson, BScPT, BPE, CAFCI
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank

Do I need a doctor’s referral to see a physiotherapist? CN

No referral is necessary to see a physiotherapist. If you have an injury that you feel is limiting you from doing what you love to do, please give us a call at 604 973 0242 (Brooksbank) or 604 929 8444 (Deep Cove).

We want everyone to be excited about achieving their personal best – whatever makes them get out there and love life! We will help you through thick and thin to achieve those goals and enjoy pain-free activity.

Paige Larson, BScPT, BPE, CAFCI
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank

If my doctor refers me for physiotherapy to another clinic, may I still go wherever I choose? OY

Yes! We hear from many patients that they appreciate our longer appointment times with hands on care (usually at least 30 minutes between appointment per physio as opposed to 20 or 15!) and often come see us after trying other clinics.

Paige Larson, BScPT, BPE, CAFCI
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank

Does my private health care insurance cover physiotherapy? AL

Extended health insurance plans comes in all shapes and sizes and the vast majority of these plans will cover a portion or all of the cost of physiotherapy treatment. Some plans require a doctor’s referral for physiotherapy before the plan will cover the cost while other plans require no referral of any kind. If unsure, please contact your extended health plan provider for more specific information.

Anne Chicoine BScKin, MPT, CAFCI
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank, Deep Cove

What is a bike fit and what happens during it? CT

The first step of any bike fit is to remember to bring in your bike and your regular riding shoes be they clips or flat shoes. Also wear your regular riding clothes, possibly with some shorter sleeves to make taking measurements a bit easier when testing your flexibility.

Once you arrive our therapist will go over your history as a rider, as well as make not of any injuries that you might have had which would impact your comfort or position on your bicycle. From there the therapist will preform an assessment of your flexibility and get you on your bike.

From there they’ll make some measurements on various parts of your body. Then they will begin to adjust your bike to better fit you and discuss changes to your bike you make want to make so that your ride becomes more comfortable and efficient. One great thing about our location is with two nearby bike stores it’s easy and quick to find new parts.

Ramsey Ezzat BScPT, FCAMT
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank

Will physio fix a partial thickness tear toward the bursal surface of the suppraspinatus tendon? CB

If you can avoid surgery you should, it is recommended that you give a physiotherapist 8-10 weeks to develop a strengthen program, restore joint motion and educate you on activity modification which has been shown to decrease pain and restore strength.

Rotator cuff tears (one of the four is the supraspinatus) are common in a huge portion of the population and most are resolved with a combination of manual therapy (restoring joint motion), exercise and therapeutic modalities.

The most important thing you can do is restore joint strength and motion as soon as possible so the pain doesn’t start to travel into your neck and back because you are compensating.

You are also welcome to come to the clinic anytime for a thorough assessment and individualized treatment plan.

Dorothy Berwick MPT, BSc
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank

I recently got diagnosed with back problems... SR

“…namely: mild scolootic deformity, L5/S1 mild diffuse disc bulge, L3/4 L4/5 mild posterior annular relaxation.

I was told not to lift heavy weights or put excess pressure on my back. I used to exercise regularly and perform squats and deadlifts to target my legs and glutes. I now need new ways to target the glutes and was looking into weighted cable kickbacks, I wanted to know if this exercise will be safe for my back and will not cause further damage. Do you have any idea?”

A: It would be find as long as your core is stable, preventing any arching through the lumbar spine (low back). A way to prevent that would be to do smaller backward movements of the leg. Stop if it aggravates your low back, and start with light resistance, slowly progressing over time. The other thing would be to have higher repetitions, 2 or 3 sets of 30 reps to start. Having said this, without proper assessment, it can be difficulty to prescribe an exercise without first reviewing movement patterns and previous injuries.

If you have any questions, or want to ensure that the exercises are being done correctly, please feel free to call and book an appointment with any of our registered physiotherapists.

Jason Luce MPT, BSc
Registered Physiotherapist
North Shore Sports Medicine: Deep Cove

Will physio fix a partial thickness tear toward the bursal surface of the suppraspinatus tendon?... JT

Or is surgery?

A: If you can avoid surgery you should, it is recommended that you give a physiotherapist 8-10 weeks to develop a strengthen program, restore joint motion and educate you on activity modification which has been shown to decrease pain and restore strength.
Rotator cuff tears (one of the four is the supraspinatus) are common in a huge portion of the population and most are resolved with a combination of manual therapy (restoring joint motion), exercise and therapeutic modalities. The most important thing you can do is restore joint strength and motion as soon as possible so the pain doesn’t start to travel into your neck and back because you are compensating. You are also welcome to come to the clinic anytime for a thorough assessment and individualized treatment plan.

Dorothy Berwick MPT BSc
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank

In Feb 2013 I had surgery on my right shoulder for a torn labrum. After many months of recovery....

“…. decided to go back to the gym and make an attempt to regain the muscle and strength that I lost. My visits to the gym were going great until I got back to the bench press. I started with just the bar, which doing so I noticed there was a very strong and loud pop in my right shoulder, during the decent and just before I reached 45 degrees. I figured using a barbell put my shoulder in an awkward position, therefore I tried other variations of the bench press. These variations included floor press, dumbbell, reverse grip, as well as incline. All variations of the exercise presented the same pop at the same place, just prior to 45 degrees , therefore I decided it was too soon to resume training at the gym.

Now, a year+ later, I am again trying to reestablish my place in the gym, but the same pop is present. I have often thought the surgery was not successful or I did not heal correctly. Could this be the case? Does this merit going back to my Ortho? Or, do I simply lack the muscle/strength in my shoulders, which is prevent the success of the bench press?
Thank you for any feed back you can provide.”

A: Thanks for your question!
It is difficult to know exactly what is going on with your shoulder without doing a full assessment. However, from what you have describe, it sounds like you are experiencing some anterior instability through your shoulder. This is most likely due to weakness in your rotator cuff muscles.

The shoulder joint is a very unstable joint because of the way it is made (think of a golf ball on a tee). There are not many supports providing stability through the front of your shoulder joint. As such, the shoulder joint relies on the rotator cuff muscles to maintain good alignment within your shoulder. Following surgery and immobilization, your rotator cuff muscles can become weak and tight. If you did not complete a full post-surgical rehabilitation program to address this, then these muscles will continue to be weak and/or tight. When you are completing an exercise such as bench press you need to have adequate strength through your rotator cuff muscles to keep the shoulder joint aligned properly. If the bones are not held together securely you may experience a slight pop as the bones move too much. This may lead to future damage of your labrum. Unfortunately, exercises such as bench press do not directly target these muscles and therefore will not be beneficial at this stage. You must first begin with isolated rotator cuff exercises. A physiotherapist can guide you through a progressive resistance program, ensuring you establish correct movements and control as you get stronger. Once you have regained basic strength through your rotator cuff muscles you can begin weight bearing exercises such as push-ups focusing on a limited range of motion and good scapular control. Finally, you will be able to recommence your weighted bench press.

As you can see the shoulder is a very complicated structure with lots of factors that contribute to its stability and mobility. I strongly recommend being assessed by a physiotherapist so they can set you up with a targeted strengthening program. That will give you the best chance of getting you back to your full gym program as soon as possible.

Allison Kalls DPT BA
Registered Physiotherapist
North Shore Sports Medicine: Deep Cove

How long would it take to treat sever sciatic pain.... AZ

that has persisted for 7 weeks and it is shooting down to my foot. Can you please tell if you are working on this cases and how long would it take to completely heal my conditions according to your statistics?

Thank you for your question! In general, with regular treatment, this can be resolved within 8 weeks.
We would encourage you to seek further medical testing. You are also welcome to come to the clinic anytime for a thorough assessment and individualized treatment plan.

Paige Larson BScPT BPE
Registered Physiotherapist
North Shore Sports Medicine: Brooksbank, Deep Cove

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